实时超声支气管镜引导下经支气管针吸活检术对肺癌的诊断作用

评价实时超声支气管镜引导下的经支气管针吸活检术（EBUS-TBNA）对肺癌的诊断价值。方法:回顾分析中山大学肿瘤防治中心2010年8月至2011年2月期间，46例经胸部CT或PET-CT检查显示为纵隔和/或肺门淋巴结肿大和/或胸内气管旁肿块（≥1 cm）的患者行EBUS-TBNA的资料（其中临床拟诊为肺癌并肺门和/或纵隔淋巴结转移25例，纵隔和/或肺门不明原因淋巴结肿大21例），统计实时EBUS-TBNA在肺癌诊断中的敏感性、特异性、阳性预测值、阴性预测值及诊断率。结果:46例患者中，其中经病理学检查确诊为肺癌患者38例，淋巴结结核3例，淋巴结炎3例，结节病1例，淋巴瘤1例。46例患者中，经EBUS-TBNA诊断为肺癌34例，淋巴结核2例，淋巴结炎3例，结节病1例。38例肺癌患者共穿刺48组淋巴结，1例气管旁肿物，其中经EBUS-TBNA诊断为肺癌34例，假阴性4例，敏感性为89.5%，特异性为100%，阳性预测值为100%，阴性预测值为66.7%，诊断率为87.0%。EBUS-TBNA过程安全，全部病例无严重并发症发生，仅1例一过性发热。结论:实时EBUS-TBNA，并发症少，可在门诊进行，且诊断率、敏感性及阴性预测值高，是诊断肺癌安全、有效的方法。当常规支气管镜未能取到阳性病理结果时，亦可尝试通过对肺门或纵隔淋巴结或肺内肿块行EBUS-TBNA来诊断。 

Role of Real-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis Of Lung Cancer

To evaluate the role of real-time endobronchial ultrasound-guided transbronchial needle aspiration ( EBUS-TBNA ) in the diagnosis of lung cancer. Methods: A total of 46 patients with mediastinal, and/or hilar lymphadenopathy, and/or intrathoracic peritracheal masses ( ≥1 cm ) previously detected by CT or PET-CT scan and who underwent EBUS-TBNA between August 2010 and February 2011 were retrospectively reviewed. Twenty-five cases were diagnosed as lung cancer with hilar and/or mediastinal lymph node metastasis, and 21 cases were unknown mediastinal and/or hilar lymphadenopathy. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnosis rate of EBUS-TBNA in the diagnosis of lung cancer were calculated. Results: Among the 46 patients, pathological examination diagnosed 38 cases of lung cancer, 3 of lymphatic tuberculosis, 3 of lymphadenitis, 1 of sarcoidosis, and 1 of lymphoma. EBUS-TBNA diagnosed 34 cases of lung cancer, 2 of lymphatic tuberculosis, 3 of lymphadenitis, and 1 of sarcoidosis. In 38 lung cancer cases, 48 samples were obtained from lymph nodes, and 1 sample was obtained from an intrapulmonary lesion. A total of 34 cases were diagnosed by EBUS-TBNA, and false negatives were obtained in 4 cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnosis rate were 89.5%, 100%, 100%, 66.7%, and 87%, respectively. The procedure was safe and no severe complication occurred. Conclusion: The diagnosis rate, sensitivity, and negative predictive value of EBUS-TBNA are high. Therefore, EBUS-TBNA may be a safe and effective technique in the diagnosis of lung cancer.